• A Research Portfolio: Transformational change by nursing, midwifery and care staff across health and care

      Finnegan, Alan; orcid: 0000-0002-2189-4926; Aitkenhead, Susan (Wiley, 2019-10-07)
    • “Cautiously Optimistic” Older Parent-Carers of Adults with Intellectual Disabilities response to the Care Act 2014

      Gant, Valerie; Bates, Claire; University of Chester
      This paper discusses potential opportunities for best practice in the UK that may be brought about by the Care Act (2014). Carers in the UK were given new rights within this legislation with a focus on needs led assessment. The underpinning philosophy of the Care Act is to streamline previous legislation and offer a framework for carers and people in receipt of care, to enable a more personalised approach to care and support.
    • Nerve agents: a guide for emergency nurses. Part 1.

      McGhee, Stephen; Finnegan, Alan; Angus, Neil; Clochesy, John (2019-03-04)
      Recent incidents in the UK and the alleged chemical attacks in Syria by the Bashar al-Assad regime have brought the subject of chemical weapons back into the public domain. To date these types of event have been relatively rare because terrorist plans to harm large numbers of people have mostly been thwarted. This is the first part of a two-part article on nerve agents. Part one gives an overview of these agents, their historical background and manufacture, and how the agents affect physiology. Part two, which will appear in the next issue, considers the pre-hospital response to the use of nerve agents, including effective triage and decontamination, and in-hospital treatment. [Abstract copyright: ©2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.]
    • Clinical holding: ethical guidance for children's nurses working in the UK.

      Page, Andrea; Hejlskov Elvén, Bo; Seabra, Suzanne; Warren, Alison; McDonnell, Andrew; Lucy Mortiboys, Imogen; Vanes, Nicola (2019-07-09)
      This article explores ethical decision-making surrounding clinical holding of children and young people in healthcare environments with the aim of enhancing autonomy and engagement on their behalf. A considerable body of evidence, published over the last 20 years, suggests that this complex and challenging area of practice is not always well managed, with mixed messages about the nature of consent, choice and negotiated practice countered by best interests decisions taking precedence ahead of the child's wishes. An ethical framework is proposed comprising four levels of value-based interventions and how they may be applied in clinical practice, allowing for increased engagement, empowerment and support on behalf of children and young people in relation to clinical holding decisions. [Abstract copyright: ©2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.]
    • Responding to nerve agent poisoning: a guide for emergency nurses. Part 2.

      McGhee, Stephen; Finnegan, Alan; Angus, Neil; Clochesy, John Michael (2019-04-16)
      The release of chemical agents can cause loss of life and result in major incidents. Chemical agent-related major incidents require a modified response by emergency services due to the chemicals' transmissibility, lethality, latency and persistence. In general, modifications to casualty flow, triage and treatment are made to reduce transmissibility, and lethality of chemical hazards. This article, the second of a two-part series on nerve agents, describes the adapted response and explains how emergency nurses must be familiar with principles of care including incident and casualty management. [Abstract copyright: © 2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.]
    • Exploring Public Perceptions and Understanding of Dementia: Analysing Narratives from the Mass Observation Project

      Olsen, Veronica; Taylor, Louise; Whiteley, Kirsty; Ellerton, Annie; Kingston, Paul; Bailey, Jan; University of Chester (Sage, 2019-07-10)
      Over 850,000 people living in the United Kingdom have been diagnosed with dementia, yet knowledge about this condition amongst the general population remains relatively poor. Many studies have evaluated the level of public knowledge and understanding about dementia from a research and professional service perspective, however none have considered this condition from the perspective of the wider public. In this preliminary overview, we analyse and describe high level narratives collected from 143 respondents to a dementia Directive commissioned to the Mass Observation Project. These narratives present a perspective on the public knowledge and understanding about dementia not previously considered, where respondents have written openly about their own experiences, and reflected on their perception of the wider public’s knowledge and understanding about dementia. This unique perspective importantly enhances our knowledge about the public’s understanding and awareness of dementia, and informs the main areas of public concern found in the analysis: care responsibilities, impact on relationships, and fears about developing dementia.
    • Inadequate dried blood spot samples for Early Infant Diagnosis, how common and what are the reasons for rejection in Zimbabwe?

      Chiku, Charles; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; Mangwanya, Douglas; et al. (PLoS, 2019-08)
      Background Early infant diagnosis (EID) of HIV in infants provides an opportunity for early detection of the infection and early access to Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of HIV-exposed infants, born from HIV positive mothers. However, DBS rejection rates have been exceeding in Zimbabwe the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL). The aim of this study was to determine the DBS samples rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the sample was collected. Methods Analytic cross-sectional study using routine DBS samples data from the NMRL in Harare, Zimbabwe, between January and December 2017. Results A total of 34.950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected and reasons for rejections were: insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross contamination (6%), mismatch information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities had five times likelihood to be rejected compared to those from a central hospital. Conclusion Rejection rates were above the set target of 2%. The reasons for rejection were ‘pre-analytical’ errors including labeling errors, sample damage, missing or inconsistent data, and insufficient volume. Samples collected at primary healthcare facilities had higher rejection rates.
    • Does preceptorship support newly qualified midwives to become confident practitioners?

      Black, Sophie E.; University of Chester (British Journal of Midwifery, 2018-12-05)
      Aim: The aim of this literature review is to analyse the literature in order to answer the research question of ‘does preceptorship for newly qualified midwives support them to become competent and confident practitioners?’ Methods: Using a systematic review process, literature was searched for and using an inclusion/exclusion criteria either eliminated or deemed appropriate to use. There were six pieces of relevant literature that met the inclusion criteria. Themes were derived from the chosen pieces of literature via thematic analysis and analysed. Results: The themes derived from the literature consisted of two main themes; a named lead for the preceptorship programme was beneficial and the time that midwives had to complete the programme was insufficient. Three sub-themes were also identified as important consisting of; feedback and reflection, supernumerary time and ability of the preceptor. Conclusion: There is an evident lack of primary research into newly qualified midwives, preceptorship and gaining competence and confidence. More primary research is needed to assess this notion. In addition, preceptors also need to be trained to ensure they have the right attributes to adequately support, teach and assess junior midwives.
    • Common causes of EID sample rejection in Zimbabwe and how to mitigate them

      editor: Torpey, Kwasi; Chiku, Charles; orcid: 0000-0003-3455-598X; email: charleschiku@gmail.com; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; et al. (Public Library of Science, 2019-08-08)
      Early infant diagnosis (EID) of HIV provides an opportunity for early HIV detection and access to appropriate Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of exposed infants, born to HIV-positive mothers. However, DBS rejection rates in Zimbabwe have been exceeding the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL), in Harare. The aim of this study was to determine the DBS sample rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the samples were collected. This is an analytical cross-sectional study using routine DBS sample data from the NMRL in Harare, Zimbabwe, between January and December 2017.A total of 34 950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected. Reasons for rejection were insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross-contamination (6%), mismatch of information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities were five times more likely to be rejected compared to those from a central hospital. Rejection rates were above the set target of <2%. The reasons for rejection were ‘pre-analytical’ errors including labelling errors, missing or inconsistent data, and insufficient blood collected. Samples collected at primary healthcare facilities had higher rejection rates.
    • Using and developing evidence in health and social care practice

      Chapman, Hazel Margaret; University of Chester (Sage, 2020)
      [A] Overview This chapter outlines the processes of developing evidence-based practice and carrying out research and highlights the similarities and differences between the two. This chapter aims to increase your skills and motivation in utilising research evidence to improve your practice, introduce you to the process of research and develop your research skills. [A] Learning Outcomes At the end of this chapter you will be able to: • Critique research papers. • Share best practice with your colleagues. • Assist with research in practice. • Develop your research skills with a view to becoming a researcher.
    • Lived experiences of negative symptoms in first-episode psychosis: A qualitative secondary analysis

      Gee, Brioney; Hodgekins, Jo; Lavis, Anna; Notley, Caitlin; Birchwood, Max; Everard, Linda; Freemantle, Nick; Jones, Peter B.; Singh, Swaran P.; Amos, Tim; et al. (Wiley, 2018-03-24)
    • Use of storytelling and audio podcasts in qualitative research

      Sutton, Julie E.; University of Chester (RCNI, 2019-08)
      The author discusses the use of service user story telling through the medium of audio podcasts, in service evaluation. The author argues this is an effective way to promote service user participation in service improvement projects and highlights how audio podcasts can stimulate emotional connections in service evaluators leading to informed identification of priorities for change
    • A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe

      Machekera, Shepherd; Wilkinson, Ewan; Hinderaker, Sven G.; Mabhala, Mzwandile A.; Zishiri, Christopher; Ncube, Ronald; Sandy, Charles; Timire, Collins; Takarinda, Kudakwashe; Sengai, Tonderai; et al. (International Union Against Tuberculosis and Lung Disease, 2019-06-21)
      Setting: 10 districts and 3 cities in Zimbabwe Objective: To compare the yield and relative cost of identifying a case of tuberculosis (TB) if the National TB Programme (NTP) used one of three World Health Organisation (WHO)-recommended algorithms (2c,2d,3b) instead of Zimbabwe’s active case finding (ACF) algorithm Design: Cross-sectional study using data from the Zimbabwe ACF project. Results: 38,574 people were screened from April-December 2017 and 488 (1.3%) were diagnosed with TB. WHO-2d had the least number of people needing a chest X-ray (CXR) at 13,710 (35.5%) and bacteriological confirmation at 2,595 (6.7%). If the NTP had used the WHO recommended algorithms, fewer TB cases would have been diagnosed - 18% (88 cases) with algorithm 2b, 25% (122 cases) algorithm 2d, and only 7% (34 cases) with algorithm 3b. The relative cost-per-case of TB diagnosed for the Zimbabwe algorithm at $565 was over three times that of WHO 3b algorithm ($180) which was the cheapest. Conclusion: The Zimbabwe ACF algorithm had the highest yield but at a considerable cost when compared to WHO algorithms. The trade-off between cost and yield needs to be reviewed by the NTP and changing to use algorithm 3d considered.
    • Stigma: a linguistic analysis of personality disorder in the UK popular press, 2008-2017.

      Bowen, Matt; University of Chester (Wiley, 2019-06-25)
      Introduction: Many people with a diagnosis of personality disorder experience stigma, and the press’ representations may contribute to those processes. To date little is known about how the press write about people with personality disorder and analysis of language used is often limited to checklists of words to avoid. Aim: The aim of the study was to explore the linguistic characteristics of press articles about personality disorder in popular tabloids in the UK and consider the implications for stigmatisation. Method: Corpus linguistics was used to examine a 50% sample of all articles published by the popular press in the UK, from 2008 to 2017, that referred to personality disorder (n=260). Results: The findings identified a range of words that constructed narratives of violence. Discussion: The method enabled the findings to expand the current level of knowledge in the field, identifying patterns in the use of the language of violence, which may contribute to the processes of self-stigma. Implications for Practice: Greater understanding of the messages in the press can sensitize nurses to common misconceptions about the disorder, how these may have become internalised and the need for psycho-social interventions to address the impact of self-stigma on self-esteem.
    • A Whole Systems Approach to Hospital Waste Management in Rural Uganda

      Kwikiriza, Stuart; Stewart, Alex G.; Mutahunga, Birungi; Dobson, Andrew E.; Wilkinson, Ewan (Frontiers Media S.A., 2019-06-06)
      Introduction: Safe waste management protects hospital staff, the public, and the local environment. The handling of hospital waste in Bwindi Community Hospital did not appear to conform to the hospital waste management plan, exhibiting poor waste segregation, transportation, storage, and disposal which could lead to environmental and occupational risks. Methods: We undertook a mixed-methods study. We used semi-structured interviews to assess the awareness of clinical and non-clinical staff of waste types, risks, good practice, and concerns about hospital waste management. We quantified waste production by five departments for 1 month. We assessed the standard of practice in segregation, onsite transportation, use of personal protective equipment, onsite storage of solid waste, and disposal of compostable waste and chemicals. Results: Clinical staff had good awareness of waste (types, risk) overall, but the knowledge of non-clinical staff was much poorer. There was a general lack of insight into correct personal or departmental practice, resulting in incorrect segregation of clinical and compostable waste at source (>93% of time), and incorrect onsite transportation (94% of time). In 1 month the five departments produced 5,398 kg of hazardous and non-hazardous waste (12; 88%, respectively). Good practice included the correct use of sharps and vial boxes and keeping the clinical area clear of litter (90% of the time); placentae buried immediately (>80% of the time); gloves were worn everyday by waste handlers, but correct heavy-duty gloves <33% of the time, reflecting the variable use of other personal protective equipment. Chemical waste drained to underground soakaways, but tracking further disposal was not possible. Correct segregation of clinical and compostable waste at source, and correct onsite transportation, only occurred 6% of the time. Conclusion: Waste management was generally below the required WHO standards. This exposes people and the wider environment, including the nearby world heritage site, home to the endangered mountain gorilla, to unnecessary risks. It is likely that the same is true in similar situations elsewhere. Precautions, protection, and dynamic policy making should be prioritized in these hospital settings and developing countries.
    • An exploration of issues affecting the assessment of social work students on practice placement in England

      Caffrey, Bridget; Fruin, Helen; University of Chester (Whiting and Birch, 2019)
      This article explores issues affecting assessment of social work students on practice placements in England. The authors have many years of experience in this area of social work and aim to highlight concerns about the complexity of assessment in practice settings. This report draws on research presented by Bailey-McHale and Caffrey (2018) at the 12th International Conference on Practice Teaching and Field Education in Health and Social Work in order to consider student perspectives. These highlight a sense of feeling powerless and judged. This article also explores the wider issues potentially impacting on the assessment of students practice. Acknowledging the challenges of all assessments, we consider how assessment of student practice may be further complicated by factors including the role and demands of universities, the impact of training and support for practice educators and pressures within current social work practice. This commentary highlights longstanding inequalities within social work assessment on placements for some student groups, including BAME students. The authors draw on Brookfield’s (1998) reflective lenses and encourage the social work profession to reflect and consider how current practice might be improved. The authors invite ideas and feedback to stimulate a professional debate and new ideas.
    • Experiences of sleep hygiene education as an intervention for sleep problems in children with developmental disabilities: Findings from an exploratory study.

      Sutton, Julie E.; Huws, Jaci C.; Burton, Christopher R.; University of Chester and Bangor University (Wiley, 2019-05-16)
      Behavioural sleep problems in children with developmental disabilities that involves advising parents on sleep‐promoting behaviours; however, it is supported by a limited evidence base. Materials and methods: This exploratory study aimed to enhance qualitative understanding and explore stakeholder perceptions about experience, current practice and ideas around the implementation of SHE. Parents of children with developmental disabilities and sleep problems (N = 9) and sleep practitioners (N = 11) took part in semi‐structured interviews and focus groups, and data were thematically analysed. Results and discussion: The analysis identified four parent themes: Beliefs about sleep problems; Getting professional help; Ways of knowing about sleep; and Visions of sleep support. Two practitioner themes were also identified: Sleep service accessibility and Inconsistent sleep support. Conclusion: The findings provide further insight into how parents of children with developmental disabilities experience sleep problems, and how SHE is currently implemented. These have implications for both policy and practice.
    • Epidermolysis bullosa: how social support affects quality of life

      Butterworth, Sondra; Mitchell, Andrew E. P.; Mason-Whitehead, Elizabeth; Martin, Kate; University of Chester (EMAP, 2019-05-01)
      Measuring quality of life has become an increasingly important method of evaluating the effect of health and social care interventions. The rare genetic condition epidermolysis bullosa is known to have a deep social impact on people’s quality of life, but most research into the condition is focused on its biomedical aspects and attempts to find a cure. A literature review has explored the relationship between social support and quality of life in people with epidermolysis bullosa. It concludes that, while more research is needed, social support does have a positive impact on quality of life and that professionals should adopt a bio-psychosocial approach to management.
    • Nurses' experiences of communicating respect to patients: Influences and challenges

      Clucas, Claudine; Chapman, Hazel M.; Lovell, Andy; University of Chester (Sage, 2019-04-04)
      Background: Respectful care is central to ethical codes of practice and optimal patient care, but little is known about the influences on and challenges in communicating respect. Research question: What are the intra- and inter-personal influences on nurses’ communication of respect? Research design and participants: Semi-structured interviews with 12 hospital-based UK registered nurses were analysed using interpretative phenomenological analysis to explore their experiences of communicating respect to patients and associated influences. Ethical considerations: The study was approved by the Institutional ethics board and National Health Service Trust. Findings: Three interconnected superordinate themes were identified: ‘private self: personal attitudes’, ‘outward self: showing respect’ and ‘reputational self: being perceived as respectful’. Respectful communication involved a complex set of influences, including attitudes of respect towards patients, needs and goals, beliefs around the nature of respectful communication, skills and influencing sociocultural factors. A tension between the outward self as intended and perceived presented challenges for nurses’ reputational self as respectful, with negative implications for patient care. Discussion: The study offers an in-depth understanding of intra- and inter-personal influences on communicating respect, and sheds light on challenges involved, helping provide practical insights to support respectful care. Conclusion: Findings stress the need for improved conceptualisations of respect in healthcare settings to formally recognise the complex attitudinal and socially constructed nature of respect and for appropriate professional training to improve its communication